Detection of Portal Venous Gas by Point-of-Care Ultrasound in Severe Abdominal Disease: A Case Series

Portal venous gas (PVG) is an uncommon but critical finding for emergency physicians (EPs) to recognize on point-of-care ultrasound (POCUS). Gas bubbles appear as hyperechoic foci flowing in the proximal vasculature and may appear as linear structures in the distal veins. This series describes three patients presenting with complaints of abdominal pain in whom POCUS examination identified PVG. In all three cases, serious abdominal pathology (one case of acute mesenteric ischemia and two cases of necrotizing intestinal infection) was confirmed with additional workup. PVG is associated with serious abdominal pathology, and although it is not pathognomonic for mesenteric ischemia, this condition remains the most frequent underlying cause of PVG. Mortality among patients with PVG varies but can be very high. EPs should familiarize themselves with the appearance of PVG on POCUS and remain vigilant for this finding while evaluating their patients.